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FOR OFFIC_ USE: <br /> ...................................... ' <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ...................... <br /> ...............•................•.. •. (Complete in Duplicate) <br /> ..... ......•• •. .......... . . This Permit Excires 1 Year From Date Issued Date <br /> -1'=_*+cation is hereDy mown Lcca+ �eaith D+5' <br /> - <br /> cnc: cem <br /> -.For O = it to G=nStrliC' end �:+s7olf the work her-_:m descnoec. <br /> :ni; application is made " e to the Sen Jcao <br /> n compliance with County Orcinancs No. 549. <br /> 48 ADDRESS A LOjCAT10N <br /> ......................-....... - ' <br /> L z Name.__._ <br /> .._._.���__. _. _.�. , 1-.d' G4'�..------ - --- ------- Phone...........-.......... <br /> .�..ocndrrreascsb---r-'-z-N- a Lr - <br /> - --- <br /> �- Pho '� %---- � ---•-----•--•------------------ _ <br /> Installation will serve: Residence ( partment douse ❑ Commercial E] Trailer Court 0 Motel a Other a <br /> Number of living units: .-1_- Number of bedrooms-I... Number of the --�ot size ._L2il <br /> Water Supply: Public system ❑ Community system 0 Private Depth to Water Table ------ tt_ <br /> Character of soil to a depth of 3 feet: Sand Q Gravei ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Q Hardpan ❑ <br /> Previous Application Mede: (lf yes,dOTe........... ._..:-._i No 0 New Construction: Yes ❑I No;*--FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICAMNS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet_) --� <br /> 3e0c Tank: Distance from nearest weiJ( !.-_.._Dista fro noun t _______.MeteriaL.___�__ <br /> rr Ca <br /> No. of comportments__................Size_ liquid depCapacity p ty.._._.......-..-___-. <br /> os el Distance from nearest Weil- Distance Ista�ce from foundation Distance to nearer' lot line__. <br /> Number of lines________ :. .,.-..len th of each line__1_Q.� Width o: trench_ ��`f-_... .-. <br /> ....E-- <br /> .t-- TYPa of filter *+ateri -._..Depth of filter materiel___ ^. --Total length_._- .. .... <br /> Seepage Pir: D15tance-4neeres+ well._._._-.________..Dis+once from foundation----------_-_--Distance to nearest lot fine___.. ..,•.. <br /> ❑ Number'of pits-------------•-----Lining materia(... .-- -- Size: Diameter----------------------Dep+h-•---,---------------------- 4 <br /> Cesspooi. Dis`ance from nearest weil_______ �Distence from foundation___'...............Lining material____-__--.......-._. -- <br /> ❑ Sze- Diameter-------------- .....------------Depth-------------------------------------------__liquid <br /> Privy: Distance from nearest well....................__-... ----------Dieancs from nearestbuild+n � <br /> ❑ Distance to nearest lot line--- --................---------........_.-----�..._._..-- --. ��' <br /> Remodeling and/or repairing( describe .._._.__ _-.... <br /> r—.____.___--_.._„--------------«.-_–..__—_-------------__._.._.-___–_--_- 1�fyQli3�_......•v..•_____ <br /> __............. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws.c�d rules and regulations of the San aquin Local Health District. <br /> (Signed)------------� _✓ �'�---_---- ..--- -- - -(Owner and/or Contractor) <br /> 3EF''Ml= TANK seR"gE <br /> BY�iS�ht nLe, - — _-_---_. _._(Tithe).- ------------------------_------------- <br /> ?Plot plan, showing uze of to of system in relation wells, buildings, etc.. can be placed on reverse side). <br /> FOR D RTMENT USE ONLY <br /> aP'_cAT lcN TED aY._ - ........ _ ---- -—— DATE lam- 7-G6 <br /> ..r_... . __._ DATE-------------•-----.---------- <br /> K;ILDiNG PERMIT ISSUED_.._. .._-.�_.--------------•---------___-...__... •------------•-_------ -- <br /> Alterations and/or recommendations:,-- ------ ----------------.--_. -- .----..--_-•---------------r«�»---�::» <br /> .......-.............................._...,.._------ r-- - -....._._ _--..............._,-------..-----------------------------•-•-------------------• -----------_---- <br /> - .,AL Ncac^-iCr l 3X�`� - `4' ........I. ........ . ........-..L............-......................----_-•-- <br /> SAN JOAQUIN LCCAL HEALTH DISTRICT <br /> 1441 U Hmwll n Avg_ 300 Wur Oak Ste.*# 124 Syeebwse­$1rnN 205 woo gt%str"t <br /> Srvcklon, Ga/lfo•nia Lsdi, Coiirorn.o Wereee, Coiirorma Tracy, Ca+itarmia <br />